EYE REMOVAL SURGERY
This booklet explains several conditions that require total or partial eye removal and how to take care of your prosthesis.
The conditions that require eye removal surgery are:
1) Malignant ocular tumors: the eye is removed to prevent cancer from spreading to the entire body as is the case of children with retinoblastoma. The eye must be removed if the patient does not respond to treatment or if the cancer could spread to the optic nerve, which connects the eye to the brain, since it could lead to death.
2) Endophthalmitis: If the eye does not respond to treatment or the inflammation reaches an advanced stage that it spread to close tissues threatening the safety of the structures surrounding the eye, the eye must be removed.
3) Painful, blind eye: A patient may complain of loss of vision and severe, persistent pain in his eye despite regular use of prescribed medication. In this case, the pain could be the result of high intraocular pressure, and therefore the eye is removed to stop the damage caused by its presence.
4) Unsightly, blind eye: the eye is removed for cosmetic reasons and replaced by an artificial eye.
5) Eye injuries caused by accidents and fireworks.
How is the decision to remove the eye made?
First, the doctor fully examines the patient. If he concludes that the only possible treatment is to remove the eye, he then discusses the decision and reasons in detail with the patient. After that, the decision to undergo the procedure is up to the patient if he is capable, and if he is a minor or legally incapable of making a decision, it would be the responsibility of his legal guardian. The patient or his/her guardian gives the approval by signing a consent form to undergo this procedure.
How is the operation performed?
There are two types of eye removal operations:
1) Enucleation: the whole eyeball is removed and replaced with an orbital implant.
2) Evisceration: the contents of the eyeball are removed leaving the sclera, the white layer covering the surface of the eyeball, and placing an orbital implant inside it.
In both surgeries, the space resulting from removing the eye is filled with an orbital implant to prevent the eyelids from shrinking and to maintain an aesthetically pleasing appearance. A temporary clear lens is placed inside the eye until the patient receives an artificial eye.
What happens after the surgery (first days)?
The patient is instructed not to rub his eye or apply water to it to minimize complications and infection.
The patient may suffer from pain or headache in the side that was operated on. Tears could appear pink due to the blood in the socket after the operation. It is a normal condition after surgery and it disappears within a few days.
After the wound heals, the patient is scheduled for the Anaplastology Division, which is specialized in making artificial eyes. During the visit, the patient will be fitted for an artificial eye matching the size and appearance of the remaining eye and that will take 4-6 hours.
Issues Related to Eye Removal Surgery and Recovery:
Stress and anxiety are the first problems that a patient may encounter before surgery.
To deal with this, we recommend the following:
1) Keep busy with matters other than the surgery and the post-surgical period.
2) Rationalize that the loss of vision and sacrificing one eye to survive or eliminate pain is a pretty good deal.
3) Realize that daily life would not be significantly different than the way it was before.
By following these tips, the patient will find that there is no noticeable difference between life before and after surgery.
It is possible to feel pain in the wound after the operation for almost five days. The patient would not feel severe pain unless s/he jerks the remaining eye from side to side since that causes a reaction in the muscles of the removed eye. To avoid that, the eye should be moved slowly.
To avoid depression after the surgery, we suggest the following:
1) The best defense against depression is to get up and practice your normal life as it was before the operation.
2) It is helpful to visit a qualified psychologist who will offer help and support in overcoming that psychological stage.
Post Operative Tips:
· Use your fingers to measure the distance between you and other objects, e.g. when pouring liquids to avoid spilling them on the ground.
· Make use of your full head motion when you are moving to compensate for the deficiency in the visual field caused by losing an eye, e.g. turning your head to extreme right and left before crossing the street.
· It may be helpful to place marks using tape or markers on the top and bottom of stair steps to clearly see where to set your feet.
· By time, you will regain depth perception. For instance, if you recognize the size of a soft drink can by touch, this will be your guide to guess the approximate distance according to how it appears in size. If it is larger than usual, then it is closer to you, and vice versa.
· Always wear plastic safety glasses to protect the remaining eye.
· Practice walking on a straight line.
· Practice throwing a rubber ball on targets inside the house to develop your control ability and dimensions perception.
· Try to grab things such as cups, etc. with your hands when you are inside the house to get used to your vision.
Questions & Answers:
The followings are some of the common questions that are asked by patients or their families after the surgery:
What will I look like following surgery? Will I have a hole where my eye was?
With the eyelids closed, your appearance will be unchanged. However, when your lids are open, you will see the conjunctiva covered by a conformer ( conjunctiva is the pink tissue resembling the mucous membrane inside your mouth). This tissue covers the baseball implanted in the socket, which fills the space created after removing the eye.
What is the conformer? What should I do if the conformer comes out?
The conformer is an oval-shaped plastic shell with a central hole. Its function is to maintain the shape of your eyelids until you get your prosthesis. If the conformer comes out, you can put it back in. First, wash it with a sterile eye solution. Then, pointing the tip of the conformer towards your nose, put it under the upper lid, pull down the lower lid and blink. The conformer will go back into its place.
How do I clean my socket?
Special care must be given to the socket until it heals completely and during the period of time immediately following the procedure. You should clean your closed eyelids using a cotton ball moistened with a sterile eye solution the same way you will be taught at the hospital. Drops or ointment may be prescribed to protect the socket from infection. The healing period usually takes about two to four weeks.
When you receive your artificial eye, you may wash your face normally. When you remove your prosthesis to clean it, wash it under running water and never use anything that could damage its smooth surface. Your anaplastologist will monitor the way you take care of your prosthesis and you can ask him about the best way to do that.
Does the prosthesis move naturally?
Yes, but to certain limits and it differs from one case to another.
When will I get my prosthesis?
Before discharge, you will be scheduled for a check-up at the Oculoplastic and Orbit Clinic. After that, you will be scheduled for a prosthesis fitting at the Anaplastology Division.
Will my prosthesis look like my remaining eye?
Yes, the prosthesis will match the remaining eye in appearance and color. The size of the pupil will be normal, but it will not grow larger or smaller in response to light as it does in the normal eye.
Remember to take enough rest before your appointment with your anaplastologist since the process of fitting your prosthesis and drawing on it to match the remaining eye as well as other procedures may take a long time( from 4 to 6 hours).
Will I be able to do everything I used to do before?
Yes, although you will have to make a few adjustments to your daily life to compensate for the deficiency in your field of peripheral vision.
Do I need to wear eye glasses?
Your doctor may advise you to wear glasses to improve your vision or as an added protection for your good eye.
Can I wear make up?
Will I be able to drive?
Yes, you can learn or continue to drive as long your vision enables you to do so. Your doctor could advise for or against that according to your visual acuity. Please note that it is important to learn how to drive with one eye since it requires patience and additional support equipment.
Can I go swimming?
Yes, you can go swimming. However, wearing goggles or a mask is recommended.
Is it normal to have mucous or other discharge?
Yes, most patients experience a normal amount of mucous discharge. However, if the amount increases changes in color or develops an odor, you need to see your ophthalmologist immediately to check for any signs of infection.
Washing Your Artificial Eye at Home:
Sanitary care of your prosthetic eye is essential for its health and cosmetic appearance. Hygiene is an important part of taking care of your prosthesis. Follow these steps when you wash your prosthetic eye:
1) Wash your hands with water and soap.
2) Fill a pot with 1 liter of water (two 0.5 liter bottles of mineral water).
3) Add 1 teaspoon of salt.
4) Bring the solution to a boil for 15 minutes, and then leave it aside to cool.
5) Store the solution in bottles in the refrigerator (keep these bottles out of reach of children).
Note: Use the solution as per the ophthalmologist's or anaplastologist's instructions.
Revised June 2011